Your ‘normal' cholesterol and blood pressure may not be normal anymore
· Yahoo HealthAmericans should start guarding against heart disease earlier - and aim for lower cholesterol and blood pressure than ever before, according to new guidelines from the nation's leading medical associations for heart health.
The American Heart Association, American College of Cardiology and other professional medical societies released updated cholesterol guidelines in March and blood pressure guidelines in August. Both address critical risk factors for preventing heart disease, the leading cause of death in the U.S. for the past century.
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For both cholesterol and blood pressure, the key takeaway is that Americans should aim for lower levels and strive for earlier, more aggressive screening and intervention to prevent heart attacks, strokes and heart failure
Here's what experts say are the most important changes and what they mean for your health.
What do the new cholesterol guidelines say?
Explicit targets for LDL (‘bad cholesterol') levels
According to the new guidelines, everyone should aim for an LDL of less than 100 mg/dL to prevent heart attacks and strokes. Those at high risk, such as those who've previously had a heart attack or stroke, should aim for less than 70 mg/dL.
Those at very high risk, with recurrent cardiovascular events (heart attacks, strokes, peripheral artery disease) should aim for less than 55 mg/dL - down from the 70 mg/dL the previous guidelines recommended.
Guidance for children
The guidelines also more explicitly state that children can start getting screened for LDL cholesterol at age 9 to 11.
New risk calculator
Both sets of updated guidelines include a new risk calculator, "PREVENT" (Predicting Risk of cardiovascular disease Events) that predicts an individual's risk for developing heart disease and heart failure by taking into account age, sex, BMI, family history, cholesterol levels, blood pressure, diabetes, kidney function, ZIP code and other factors.
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The calculator includes more contemporary, accurate and inclusive data than prior ones, measures risk over a longer period of time (10 years and 30 years, as opposed to 10 years only), and is designed to be used starting at age 30 (instead of 40).
This reflects one of the main themes of the new guidelines: to encourage people to think about their cholesterol earlier and throughout their lifetime, not just at certain points, said Dr. Ramzi Dudum, a UCSF cardiologist.
"That's not so much a change, but an updating of the reality that (plaque formation) isn't an overnight process," he said. "It develops over time."
Lipoprotein (a) testing
The latest guidelines also say people should get their lipoprotein (a) tested at least once in their lifetime - in more explicit language than previous guidelines did. Lipoprotein (a) is a type of cholesterol that's mostly determined by genetics, and doesn't change with diet or lifestyle. A high level is associated with increased risk of stroke, coronary disease and aortic stenosis. It is determined by a blood test.
What do the new blood pressure guidelines say?
New lower targets
The blood pressure guidelines set lower targets than before, encouraging most adults to strive for a blood pressure of 120/80 or less - lower than the 130/80 that had been considered the norm in the past.
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"Lower is better, so that's the most important takeaway," said Dr. Joshua Knowles, an associate professor of cardiovascular medicine at Stanford. "And a normal blood pressure is lower than what we used to consider."
That means many more people will qualify as having uncontrolled blood pressure, said Dr. Surabhi Atreja, an associate professor of cardiology at UC Davis Health and director of the UC Davis Resistant Hypertension Clinic.
The updated guidelines recommend more aggressive, early and immediate treatment for high blood pressure. For example, those with a blood pressure of 140/90 should start right away on a two-medication combination therapy. In the past, they would have started with one medication initially and added a second later. Those with a blood pressure of 130/80, if they have other risk factors, should be treated aggressively.
"The main emphasis is diet, exercise and lifestyle modifications but if it's not controlled, then starting medications a little earlier than how we used to eight or 10 years ago," Atreja said.
GLP-1 guidance
Also, for the first time, the guidelines factor in GLP-1 medications, which include weight loss drugs like Ozempic that are much more widely used today than they were several years ago. The guidelines recommend that people with high blood pressure who are also overweight consider seeking a prescription for GLP-1.
Lifestyle modifications
The guidelines emphasize lifestyle modifications like yoga and meditation for reducing stress, and salt substitutes like products that contain 25% potassium chloride and 75% sodium chloride. They are also stricter on alcohol consumption than before, recommending abstinence as opposed to the one-drink limit for women and two-drink limit for men that was in previous guidelines.
Why are the new guidelines important?
High blood pressure and high cholesterol are two of the most common - and mostly preventable - chronic diseases in the U.S., affecting nearly half of adults. They are major contributors to heart attacks, strokes and heart disease.
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While the prevalence of heart attacks and strokes at the population level is declining - thanks to better medications and public awareness of risk factors - the incidence of other forms of cardiovascular disease, like heart failure and death from heart failure, are on the rise, said Dr. Ankeet Bhatt, a cardiologist at Kaiser Permanente in San Francisco.
"There's some promising news, but a lot more to do," he said.
The guidelines are meant to help doctors and patients monitor their health and act earlier to prevent problems.
Atherosclerosis, the hardening of arteries that leads to heart disease, can start earlier in life than many people realize - in the teens. It progresses over time depending on genetics, blood pressure, cholesterol and whether you smoke or have diabetes.
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"The point of these guidelines is to arrest this disease if we intervene earlier," Knowles said. "An ounce of prevention is worth a pound of cure. If we can start people at high risk over their lifetime earlier, we can prevent a lot of disease."
What's driving the new guidelines?
Professional medical associations update their guidelines periodically to reflect the most recent data and therapies. There are now newer and better medications to lower cholesterol and blood pressure, and more recent data showing that lower is better.
"We're kind of in a golden age of treatments for lipid-lowering therapies," Knowles said.
Just 15 years ago, doctors were limited to one class of medications, statins, he said. Since then, there have been effective trials on other types of cholesterol-lowering drugs, including injectables.
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"The trials done to get approval for those drugs were very large and very powerful," Knowles said. "What they allowed us to see is that achieving lower LDL cholesterol levels has a remarkable benefit on reducing risk. We now have the evidence to support lower targets than we did previously."
Similarly, the new blood pressure targets are a result of recent findings supporting the benefits of lower blood pressure. Previously, there was some concern that 120/80 may be too low for older adults, but recent trials have found that this level is safe - and that stricter blood pressure control can help reduce dementia risk, Atreja said.
What should I as a patient do?
Focus on the basics: Diet, exercise and medications if needed
"Moderate exercise, at least 30 minutes a day, five days a week, can durably decrease blood pressure," Bhatt said. "A healthy diet and watching your glycemic index can lower blood cholesterol. In patients who have persistent elevations in blood cholesterol or blood pressure, there are effective therapies that can reduce this."
Moderate exercise generally means you're moving rigorously enough to get your heart rate up and feel like you can't have a conversation with someone, he said.
Consider getting a lipoprotein (a) test
"While we don't yet have specific therapies to lower lipoprotein (a), we know patients with high lipoprotein (a) benefit from control of other risk factors," Knowles said. "That's the rationale for measuring that."
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Lipoprotein (a) is not currently part of the standard lipid panel. Only an estimated 2% of the population has had their lipoprotein (a) tested because it was not previously recommended, Knowles said.
"Now that it's part of the guidelines, it'll be easier to get it measured and will become part of routine care, hopefully," he said.
Check your lifetime risk of heart disease
You can use the new PREVENT risk calculator to assess your heart disease risk.
"That is the starting point for the discussion with your doctor about what you need to do next," Knowles said.
Consider a coronary artery calcium, or CAC, test
The CAC test is a scan to check for calcium deposits in the arteries - a marker of plaque buildup and a sign that the process of heart disease may have started. The test is not new, but the new guidelines recommend it more strongly than previous guidelines did, Atreja said. A calcium score can be helpful if, say, your cholesterol level is normal but you have calcium in the arteries - that could indicate you may benefit from lipid-lowering treatment.
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This article originally published at Your ‘normal' cholesterol and blood pressure may not be normal anymore.